Provider Network

2 days ago

Anna Nagar Chennai Tamil Nadu, India Link K Insurance TPA Pvt Ltd Full time

Greetings From Link K Insurance TPA Pvt Ltd

We are Hiring Senior Executive Provider Network Management (Hospital Empanelment )

**Year Of Experience** : 2 to 5 Years ( Any Health Insurance & TPA Insurance )

**Work Location : Chennai**

**Qualification **:Any Degree

**Roles & Responsibilities**:

- Identify and empanel hospitals, clinics, diagnostic centers, and other healthcare providers to join the network.
- Maintain hospital network master with clean data and appropriately flag suspected hospitals
- Evaluate the quality of healthcare providers based on accreditation, facilities, and medical staff credentials.
- Negotiate contracts, package rates and discounts with healthcare providers to ensure competitive pricing while maintaining quality standards.
- Build and maintain strong relationships with hospital administrators, medical directors, and key stakeholders to facilitate seamless cashless claims management
- Coordinate and help cashless team in the events of disputes at the time of admission/discharge of members regarding billing by hospital
- Address and resolve any issues or concerns raised by network providers promptly and professionally.
- Ensure that the network hospitals comply with relevant state & central govt registrations and accreditation requirements.
- Stay updated with changes in healthcare policies and regulations that may impact the network.
- Analyze network performance data and generate reports for management to assess the network's effectiveness and make informed decisions.
- Close coordination with insurers on the network hospital management including empaneling hospitals as per the requirements of insurers.
- Managing the team working for network hospital management across locations.
- Constant monitoring of hospitals claims outstanding and coordinate with respective internal stake holders for payment of claims
- Close coordination with claims team on fraud and abuse control and initiation of appropriate action against hospitals involved in malpractices.

**Company Profile**

**Job Types**: Full-time, Permanent

Pay: ₹18,000.00 - ₹25,000.00 per month

**Benefits**:

- Provident Fund

Schedule:

- Day shift

**Experience**:

- Hospital Empanelment: 3 years (required)

Work Location: In person

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